Emergency Showstopper- Factors behind Delays in Final Disposition

Kazi G, Siddiqui E, Habib I, Khan I, Khan B, Feroz A, Iqbal A. Emergency showstopper-sactors behind delays in final disposition. Med Emergency, MJEM 2014; 20:9-14.
Key words: factors, delay, length of stay, emergency department

  • Authors’ affiliation
  • Article history / info
  • Conflict of interest statement
Correspondent author: Sayyeda Ghazala Irfan Kazi, MD

Assistant Professor, Department of Emergency Medicine Aga Khan University, Pakistan ghazala.kazi@aku.edu

Kazi G, MD, Siddiqui E, MD, Habib I, MD, Khan I, MD, Khan B, MD, Feroz A, MS, Iqbal A Department of Emergency Medicine Aga Khan University

Category: Original article

Received: April 9, 2014

Revised: June 18, 2014

Accepted: July 28, 2014

The authors declare no conflict of interest


Introduction: Clinical management outcome of emergency patients with delays are directly related to blocked access to the next level of care from emergency department. It predicts delay to the definitive procedure plan to manage the patient and is also a marker of hospital functional flaws. Objective: To study the frequency and associated factor of delays behind final disposition of patients presenting to the Emergency Department of a tertiary care hospital in Pakistan.

Methods: This is comparative cross sectional study, conducted at Aga Khan University Hospital. Both adult and pediatric patients were included. Comparison was done between delayed and non-delayed emergency department patients. Six hour was taken as cut-off. SPSS version 19 and MS excel 2010 were used for analysis.

Results: Out of 365 cases, 133 (36%) were pediatric and 232 (64%) were adults patients. There were 184 (50%) males. More than six hour delay was noted in 94 patients (27%). Adult patients were delayed more than pediatric patients (p<0.001). Laboratorial, radiological test and generated consults were all found highly significant difference for the delays (p<0.001). 297 (81%) were discharged home, while 17 (5%) of them were admitted.

Discussion: Overcrowding is common in Emergency Department (ED) and hence the chances of delay in disposition of patients from ED are very high which will ultimately compromise the patient care. Reducing the number of comparatively stable patients with effective triaging, ED clinics and diverting available resources towards more critical patients can reduce congestion, input and throughput. Reducing consults and unnecessary investigations with the provision of more experienced physicians & nurses is an important factor to reduce delays.

Conclusion: Extended length of stay in ED may exceed the potential capability to deliver quality care within appropriate time frame; this may lead to drastic decrease in patient and family satisfaction, leading to compromised clinical care.